title: Economic impact of training and career decisions on urological surgery.
abstract: OBJECTIVE
  Medical students and residents make career decisions at a relatively young age that have significant implications for their future income. While most of them attempt to estimate the impact of these decisions, there has been little effort to use economic principles to illustrate the impact of certain variables.
  
  
  METHODS
  The economic concept of net present value was paired with available Medical Group Management Association and Association of American Medical Colleges income data to calculate the value of career earnings based on variations in the choice of specialty, an academic vs a private practice career path and fellowship choices for urology and other medical fields.
  
  
  RESULTS
  Across all specialties academic careers were associated with lower career earnings than private practice. However, among surgical specialties the lowest difference in value between these 2 paths was for urologists at only $334,898. Fellowship analysis showed that training in pediatric urology was costly in forgone attending salary and it also showed a lower future income than nonfellowship trained counterparts. An additional year of residency training (6 vs 5 years) caused a $201,500 decrease in the value of career earnings.
  
  
  CONCLUSIONS
  Choice of specialty has a dramatic impact on future earnings, as does the decision to pursue a fellowship or choose private vs academic practice. Additional years of training and forgone wages have a tremendous impact on monetary outcomes. There is also no guarantee that fellowship training will translate into a more financially valuable career. The differential in income between private practice and academics was lowest for urologists.
authors.affiliation: Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Joshua P
authors.initials: JP
authors.lastname: Langston
authors.affiliation: Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: E Will
authors.initials: EW
authors.lastname: Kirby
authors.affiliation: Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Matthew E
authors.initials: ME
authors.lastname: Nielsen
authors.affiliation: Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Angela B
authors.initials: AB
authors.lastname: Smith
authors.affiliation: Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Woods
authors.affiliation: Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Eric M
authors.initials: EM
authors.lastname: Wallen
authors.affiliation: Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. Electronic address: raj_pruthi@med.unc.edu.
authors.forename: Raj S
authors.initials: RS
authors.lastname: Pruthi
mesh_terms: D002321:Career Choice; D004501:Education, Medical / Q000191:economics*; D005257:Fellowships and Scholarships / Q000191:economics; D005260:Female; D006801:Humans; D007182:Income; D007396:Internship and Residency / Q000191:economics; D008297:Male; D011331:Private Practice / Q000191:economics; D013038:Specialization / Q000191:economics*; D014572:Urology / Q000191:economics* / Q000193:education*
keywords: career choice; health care reform; internship and residency; salaries and fringe benefits; urology